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Rupture uterus--changing Indian scenario
Rashmi1, G Radhakrisknan, N B Vaid
1Department of Obstetrics & Gynaecology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi.
Journal of the Indian Medical Association
|May 23, 2002
Summary
Uterine rupture cases were reviewed, with previous cesarean sections being a major cause. While maternal mortality is decreasing, fetal mortality remains high, highlighting the need for improved antenatal care.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Rupture of the uterus is a critical obstetric emergency.
- Understanding the etiological factors and outcomes is crucial for improving management.
Purpose of the Study:
- To review cases of uterine rupture managed over five years.
- To identify causative factors, management strategies, and outcomes, including maternal and fetal mortality.
Main Methods:
- Retrospective review of 60 cases of uterine rupture.
- Analysis of patient records for demographic data, antenatal supervision, previous uterine scars, labor characteristics, interventions, and outcomes.
Main Results:
- 77% of cases presented with uterine rupture; 23% occurred post-admission.
- Previous uterine scar (63.3%), often from cesarean section, was the leading cause.
- Oxytocin induction/augmentation in scarred uteri and obstetrical manipulation in unscarred uteri were key factors in admitted patients.
- 80% lacked antenatal supervision.
- Obstructed labor (26.6%) and traumatic rupture (10%) were also noted.
- Repair was performed in 54% of cases; hysterectomy was required in the remainder.
- Bladder injury occurred in 9 cases.
- Maternal mortality was 3.33%; fetal mortality was 78.66%.
Conclusions:
- Previous uterine scars, particularly from cesarean sections, are a significant risk factor for uterine rupture.
- Low maternal mortality and a decreasing incidence of obstructed labor suggest evolving trends in management.
- High fetal mortality underscores the severity and urgency of uterine rupture, emphasizing the need for timely intervention and improved antenatal care.